, being sworn/affirmed on oath, state that: Respondent in this action. . I request

A domestic abuse Order for Protection was issued on that it be amended as follows:

3.

Describe in detail why the Court should issue an amended Order for Protection:

OFP401

State

ENG

Rev 8/08

www.mncourts.gov/forms

Page 1 of 2

4.

An emergency exists because of an immediate danger of physical harm to me or my child (ren). Because of the danger of physical harm, I am requesting that the court grant my request for a change in the Order for Protection immediately and until the date of the hearing for modification.

5.

Notice
To the Above Named Petitioner/Respondent: Please take Notice that on at
(Date) (Time) (Judge)

. m. at
(Address)

before requested in my affidavit above.

, I will ask the Court to change the Order for Protection as

Dated:
Signature (Sign only in front of notary public or court administrator.)

Name: Subscribed and sworn to before me this day of , . Address: City/State/Zip: Telephone:
Notary Public \ Deputy Court Administrator

Distribution
______ Certified copy or original - Return to Court Administrator with Affidavit of Personal Service attached Copy for Petitioner(s) Copy for Respondent(s) Copy for file until original returned Copy for local police department Copy for Sheriff Other: ______ Dissolution File